- South African AIDS activists have called on doctors and nurses to act in the best interests of HIV-positive pregnant women and their unborn children by not waiting any longer for an official directive to switch from single antiretroviral (ARV) treatmentto more effective dual treatment for the prevention of mother-to-child HIV transmission (PMTCT).

At a meeting of the South African National AIDS Council in November 2007 South Africa’s Deputy President and the Director-General of Health announced that public health facilities would abandon the regimen of administering nevirapine only in favour of a short course of two antiretroviral (ARV) drugs for pregnant HIV-positive women.

Nearly two months later, the new PMTCT guidelines have yet to be published and disseminated to health workers at state facilities.

Dual therapy, which is currently only available in the public sector in South Africa's Western Cape Province, is more than twice as effective as monotherapy in lowering the risk of mother-to-child transmission, and has been recommended by the World Health Organisation since August 2006.

Speaking at a press conference convened on Wednesday by the AIDS lobby group, Treatment Action Campaign (TAC), Dr Tammy Meyers, a paediatrician, noted that HIV in children had been a preventable disease for over 10 years and despite having the resources and the expertise, South Africa had fallen behind its neighbours in rolling out dual therapy.

Frustration

Meyers said 90 new patients register every month the clinic for HIV-positive children she manages at the Chris Hani Baragwanath Hospital in Soweto, Johannesburg's largest township. "And those are the ones who are fortunate enough to be found," she added. "Most die without ever accessing treatment services."

While paediatric HIV has almost been eradicated in many countries of the world, the TAC estimates that 60,000 babies are infected with HIV every year in South Africa. Experts have blamed the high rates of infection not only on the failure to switch to dual therapy, but also on poor implementation of existing PMTCT services.

According to UNICEF figures from 2006, many pregnant women are still not tested for HIV and only 59 percent of women who test positive receive nevirapine.

The Southern African HIV Clinicians Society, which represents 14,000 members working in the HIV/AIDS field, also released a statement on Wednesday, urging the Ministry of Health to finalise its changes to the PMTCT regimen.

"In South Africa, a middle-income country where the majority of women give birth in state facilities, the fact that HIV-infected women have access to a substandard regimen for protection of their children is a sad reflection on our health system," read the statement.

The society said many health professionals and provincial health departments were frustrated at not having formal permission to implement an improved regimen. Nomfundo Eland, of the TAC, said some had decided to go ahead without permission. Her organisation was offering legal and other support to any health worker penalised by the state "for acting in the best interests of parents and children."

Just ahead of the press conference, the health department announced that the National Health Council would meet on Friday to "endorse" new PMTCT guidelines.

AIDS activists have blamed the delay in adopting an improved PMTCT regimen on lack of leadership from Health Minister Manto Tshabalala-Msimang, but health department spokesperson Sibane Mngadi told a local media outlet that costing the changes had caused the delay.

The TAC acknowledged the health department's announcement but refused to comment on it until they had seen the new protocol. However, Mngadi confirmed that the new guidelines would not include a "tail" regimen of two drugs administered to HIV-positive women for a week after giving birth, to reduce the likelihood of future ARV drug resistance.

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